A Journey Towards Fairer Winds: A Reflection of Panama

FUTURE DENTIST TRISHA IN, A KECK SCHOOL OF MEDICINE DK MEDICINE FELLOWSHIP RECIPIENT, RECENTLY TRAVELED TO QUEBRADA SAL IN PANAMA WITH THE NON-PROFIT ORGANIZATION FLOATING DOCTORS, FOUNDED BY TOPANGAN BEN LA BROT, TO HELP PROVIDE DENTAL CARE FOR THE NGÄBE COMMUNITY. CHECK OUT THE VOLUNTEER OPPORTUNITIES IN THE M’ONLINE “VOLUNTEER PORTAL” TO GET DETAILS ON THE FLOATING DOCTORS FIELD TRIP OPPORTUNITIES.

“Be sympathetic to the weakest, because the odds of silver and gold are what determines our lives. Some do not have the same fate as us, so if one day we have the ability to help others, do not overlook that.”

I took this quote from a reflection that my mom wrote in Khmer, the official language of Cambodia, which makes up half of who I am. The similarities between Cambodia and Panama in terms of healthcare were also a large reason why I wanted to go on this particular trip to begin with. Beyond that, something about this Panama trip instilled a strong inclination within me to get a passport and apply. I just felt like this particular one was meant for me. It was, truly.

There are a couple of things in my life that I feel were absolutely bound to happen and this trip was one of them. It’s a bit funny though, because even a few days after coming home, I still find it hard to describe to others what my experience was like when asked. So much had happened, and it feels like an injustice to just pick one or two things to tell them about.

That being said, there are a few incidents that really stood out to me, ones that I hope to never forget as I continue on my pathway to become a dentist one day.

My most difficult moment occurred immediately after doing my oral health and education charla [Spanish for “chat”] with my partner, Jamie, as well as doing a solo one for the adults as part of my Dhablania and Kim Family Global Medicine Fellowship. It was not doing the “charlas,” per se, but I remember debriefing with Mary about everything afterwards and I couldn’t help but tear up. I had always thought that education would be the solution to everything (to a certain extent, I will always believe that). After all, that is why I spent so much time in the states trying to focus on making educational materials both in and out of dentistry. I don’t think I realized, however, that education can only take you so far when you are in a really resource-limited setting such as this one. I could preach all I want about flossing, mouthwash, toothpaste, etc., but it doesn’t do the community any good if they cannot access these materials.

Mary seemed to understand what I was saying, despite my ramblings, and she also mentioned that it’s similar for nutrition—a lot of these families don’t work, [as we know it;. they might harvest foods for their families, wait for rainwater, and fish for their survival. For an outsider to come in and say to do X, Y, and Z, can be insensitive to their culture, resources, and way of life.

I related this to how ridiculous I find it in the states that we often preach to eat healthy, but if one goes to McDonald’s, a salad costs $7 and a hamburger costs $1.50. We concluded our discussion with Mary telling me that, despite all challenges, we must remember that we are helping the community as best as we can, given the resources that both of us have. That is something to be proud of.

Another moment that was special to me was when a few of the children from the schoolhouse followed me after the charla. I didn’t recognize them at first, because they had changed out of their uniforms. Then they told me in Spanish that they were our students from earlier. They kept following me around and it was one of the cutest things that ever happened to me. I was a little confused as to what they wanted, though. When I saw them later in the day, I realized that they had seen the plastic bag of sunglasses in the pharmacy, and that was why they followed me. Unfortunately, I wasn’t as popular as I thought I was!

I was, however, popular the following day in clinic when I was shadowing some of the other charlas. Since I was the one handing out water for a demonstration, I had about a dozen children follow me telling me to refill their cups so they could drink. Those cute faces made it so hard to say no, that I ended up giving them all of my water and eventually had to run away…but then they found me near the jerry can and I had to explain, “No tengo más aqua, lo siento.” [“No more water, I’m sorry”] On the surface, it makes for a cute and funny story, but I couldn’t help but remember the fact that this community relies on rainwater as their main water source, and they do not have typical toilets or constant electricity.

Juxtaposition is one of my favorite words in the English language—my friends always make fun of me for using it, but it’s the perfect word to explain another aspect of my time in Quebrada Sal. We had a hilarious and unbelievable experience on our first day there: we walked to the beach in order to shower but were kicked off due to the filming of an upcoming reality TV show. Even more hilarious was when I learned that they wanted it to seem remote, which is why nobody could be on the beach. I couldn’t help but think that seems so contrived, especially when we, literally, just walked through mud from an actually isolated community, on this same exact island but, instead, here we are on this beautiful, white-sandy beach, that has a sign “Welcome to Paradise” right where you set foot. I wondered if all of the cameramen and actors knew the life that existed right outside of this beauty.

There is something to be said about community here. Within the first 15 minutes of setting foot on the island, while trying to find the Floating Doctors lodging area, a woman came running out of her house and asked us if there would be a dentist at the clinic the following day.

When we told her that there would be, she said, “Mañana, yo voy.” [“Tomorrow, I’ll come.”] I was surprised, honestly, because even in the states, I feel like going to the dentist is something that is severely under prioritized. I believed that most did not understand that oral health is an important part of overall health. It truly touched my heart that my first encounter in this community was dental-related.

I also had learned how much the community respects Floating Doctors. Of course, I knew about this already from talking to Dr. Ben [La Brot] and learning about the organization online, but I didn’t really get it until I experienced it myself.

Even in Bocas del Toro, I would use my broken Spanish to explain that I was a part of Floating Doctors and two people gave me their phone numbers to contact them if I ever needed help. One of those people was Toby, who apparently is a boat driver for Floating Doctors!

Dr. Ben had also explained a while back in one of our pre-departure meetings that families will come from far away and dress up in order to visit the clinic. I witnessed this, as a line started to form before we even finished setting up the clinic, and despite rain.

Another thing that I noticed, particularly in the dental clinic, during the two days that I got to assist was how respectful all of the patients were to us. They were willing to hold the tray of materials if I needed to get up and reload a syringe and waited patiently for their turn.

Something truly incredible was when I bridged what I learned in my palliative care class with this Panama trip: different cultures express pain differently. In the states, I have watched everyone, from young kids to grown men throw tantrums from receiving one anesthetic. I’ve seen patients push the dentist’s hands away, creating an unsafe environment for everyone there, especially with all of the sharp materials.

That brings me to my favorite patient: my first one. I was really lucky to swap places with the other assistant at this particular time, because I ended up with the coolest case we had seen in two days.

A young teenage girl presented with an abscess on top of a tooth, which made me realize just how different dental care is here versus a resource-rich area. Elsewhere, this would be an easy fix with a root canal, but here, we had no choice but to just extract her tooth. She was  in pain. All of the anesthetic that we gave didn’t seem to work after a certain point. I saw tears in her eyes, but she still sat calmly and let us finish.

My time in the dental clinic was one of the most meaningful. I was able to meet Dr. Philippe [Martin], who is one of the most humble and inspiring dentists I’ve ever shadowed, I realized the disparities that exist, and assisted for the first time in my life. I have always said that if I cannot become a dentist, then I don’t want to do anything else in the healthcare field because that’s just how much I feel that dentistry is for me. That thought was solidified when I stepped into the dental clinic after being around intake and realizing how uncomfortable and foreign that space made me feel. My friends noticed this, too, that even though I was nervous to be assisting, I also was elated to be there in that moment.

I feel as though a shout-out needs to be given to Dr. Philippe, who I learned has been with Floating Doctors for four years now. I do not think my experience would have been the same without him: in clinic, I told him it was my first time doing any sort of restoration mixture so I was very nervous. He told me that it was okay and that after a few times, I would be better than him. Of course, that isn’t true, but the fact that he was so humble was very inspiring.

Even outside of the clinic, he went with me to refill the can of water to clean our dirty feet and even held it for me when I tried to get all the mud off my sandals. But the most heartwarming moment was when we were on the boat leaving Quebrada Sal, he was holding some of my DK Fellowship papers that I asked for feedback from. Despite us all getting completely drenched, he made sure to keep my papers dry, even though I told him that I had more copies.

Sometimes in this field, especially in the states, I become disillusioned by all of the dentists that have admitted to me that they simply pursued a career in this path because it was lucrative or because the hours were good. It was refreshing to see someone who genuinely just wanted to help others.

My mom said something funny—that every time I called home, I was in tears. I’ll ignore the fact that she put me on blast like that, but there is some truth to that statement. I couldn’t help but think of a meme that I had seen (as ridiculous as that sounds), talking about how we first-generations are so lucky to be struggling with the highest tiers of esteem and self-actualization, when our parents were dealing with the lowest physiological and safety needs.

I realized that the Ngäbe community is dealing with the same needs that my mom went through, yet somehow I managed to remove myself from my life of privilege. In that sense, it’s hard for me to pick a favorite experience because I think I needed all of the aforementioned aspects to come together as a whole to make my time in Panama as meaningful as it was.

I had thought I lived a hard life, given that I’ve experienced what it was like to not have access to dental care because of my low socioeconomic status, at a time when I didn’t know where my next meal or shelter would come from. Now, I can say that I don’t understand, at least not in a global context.

People have always asked me what I imagine my end-all-be-all is, and I’ve always thought that it was to simply be a dentist. I had thought that if I made it that far, despite all obstacles that I thought I had faced, I would be eternally happy. I realize now that perhaps my purpose is greater, that I should do something more for the communities around me, both domestically and abroad. I hope that one day, I will  come back to Floating Doctors as a provider and do more for these communities.

Thank you so much to Floating Doctors for making my first experience abroad an unforgettable one. I’ll always remember it as I continue my pathway in dentistry.

By Trisha In

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